Protocol Overview

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Sleep Apnea - Adult #091501

Protocol Release Date

November 28, 2017

Protocol Name From Source

Berlin Questionnaire

Description of Protocol

The questionnaire asks about risk factors for sleep apnea, namely snoring behavior, wake time, sleepiness or fatigue, and the presence of high blood pressure. The protocol begins with information that an individual self-reports on height, weight, age, and sex. The 10 questions address snoring, fatigue, and high blood pressure. An algorithm is provided to classify study participants into high or low risk on the basis of their response.

Specific Instructions

None

Protocol

Height (m) ________ Weight (kg)________ Age______ Male / Female

Please choose the correct response to each question.

CATEGORY 1

1. Do you snore?

[ ] a. Yes

[ ] b. No

[ ] c. Don’t know

If you snore:

2. Your snoring is:

[ ] a. Slightly louder than breathing

[ ] b. As loud as talking

[ ] c. Louder than talking

[ ] d. Very loud can be heard in adjacent rooms

3. How often do you snore?

[ ] a. Nearly every day

[ ] b. 3-4 times a week

[ ] c. 1-2 times a week

[ ] d. 1-2 times a month

[ ] e. Never or nearly never

4. Has your snoring ever bothered other people?

[ ] a. Yes

[ ] b. No

[ ] c. Don’t know

5. Has anyone noticed that you quit breathing during your sleep?

[ ] a. Nearly every day

[ ] b. 3-4 times a week

[ ] c. 1-2 times a week

[ ] d. 1-2 times a month

[ ] e. Never or nearly never

CATEGORY 2

6. How often do you feel tired or fatigued after your sleep?

[ ] a. Nearly every day

[ ] b. 3-4 times a week

[ ] c. 1-2 times a week

[ ] d. 1-2 times a month

[ ] e. Never or nearly never

7. During your waking time, do you feel tired, fatigued, or not up to par?

[ ] a. Nearly every day

[ ] b. 3-4 times a week

[ ] c. 1-2 times a week

[ ] d. 1-2 times a month

[ ] e. Never or nearly never

8. Have you ever nodded off or fallen asleep while driving a vehicle?

[ ] a. Yes

[ ] b. No

If yes:

9. How often does this occur?

[ ] a. Nearly every day

[ ] b. 3-4 times a week

[ ] c. 1-2 times a week

[ ] d. 1-2 times a month

[ ] e. Never or nearly never

CATEGORY 3

10. Do you have high blood pressure?

[ ] Yes

[ ] No

[ ] Don’t know

Scoring Berlin Questionnaire

The questionnaire consists of 3 categories related to the risk of having sleep apnea. Patients can be classified into high risk or low risk based on their responses to the individual items and their overall scores in the symptom categories.

Categories and scoring:

Category 1: items 1, 2, 3, 4, 5

Item 1: if ’Yes’, assign 1 point

Item 2: if ’c’ or ’d’ is the response, assign 1 point

Item 3: if ’a’ or ’b’ is the response, assign 1 point

Item 4: if ’a’ is the response, assign 1 point

Item 5: if ’a’ or ’b’ is the response, assign 2 points

Add points. Category 1 is positive if the total score is 2 or more points.

Category 2: items 6, 7, 8 (item 9 should be noted separately)

Item 6: if ’a’ or ’b’ is the response, assign 1 point

Item 7: if ’a’ or ’b’ is the response, assign 1 point

Item 8: if ’a’ is the response, assign 1 point

Add points. Category 2 is positive if the total score is 2 or more points.

Category 3 is positive if the answer to item 10 is ’Yes’ OR if the BMI of the patient is greater than 30kg/m2.